Understanding the MOHO in Occupational Therapy

Having survived several challenging years of occupational therapy grad school, we have to be honest…learning about theories, models, and frameworks in school isn’t always one of the most fun aspects of becoming an OT.

However, after practicing occupational therapy for several years now, it’s now easy to see the importance of these theories daily.

It goes without saying that theories, models, and frames of reference are the foundation to occupational therapy. Understanding these building blocks will allow you to grow even more as a practitioner.

Therefore, it’s only fitting that we cover one of the most important models or framework to understand as an occupational therapist – the Model of Human Occupation (MOHO).

What is the Model of Human Occupation (MOHO)?

The Model of Human Occupation (or MOHO) is a very important occupation-based framework and is woven into the fabric of occupational therapy. It utilizes a top-down holistic approach to looking at the individual, their meaningful activities or occupations, and relationship with their environment.

It is also reported to be the most frequently used occupation-based model among OT practitioners (NBCOT, 2004). Another study showed more than than 80% of occupational therapists regularly use MOHO in their practice.

For a more textbook definition:

The MOHO explains how occupations are motivated and organized into daily life patterns and performed within a person’s environment.

In more practical and real-life terms, I like to think of the MOHO as a way to organize and understand how to use occupations into practice to improve people’s health by understanding how and why meaningful activities are motivated, patterned, and performed.

Within this definition are three very important terms that are key to understanding the MOHO – volition (motivation), habituation (habits, roles, patterns), and performance.

Furthermore, the MOHO is based on an open systems theory, which states that a human is a self-organizing system in interaction with the environment, where humans interact with their environment through occupations and receive input and output.

Input is defined as when an individual attends to information of interest or relevance within their environment and then act upon it with an output, or occupation. By interacting with the environment, a person receives feedback (input) which creates change over time.

The key to the MOHO is understanding that all components within it are dynamic. When any part of it changes (skills, values, roles, habits, routines, environment), the entire dynamic may shift in either a healthy or unhealthy way for the individual.

How Did the MOHO Originate?

While covering the MOHO’s importance in occupational therapy, we also need to briefly discuss where this model came from. If you don’t remember from OT school, the MOHO originated from Dr. Gary Kiehlofner’s Occupational Therapy Master’s thesis in the 1970’s, and grew from there with the help of many other occupational therapy practitioners along the way. It’s goal was to articulate an approach to occupation-based interventions.

Now as a leading theory in occupational therapy, the MOHO is continually studied and supported by over 400 research articles and textbook chapters. The MOHO also has it’s own textbook, Kielhofner’s Model of Human Occupation: Theory and Application, currently in it’s 5th edition.

This textbook, regularly updated, aims to “deliver the latest in MOHO theory, research, and application to practice; [and] includes new case studies that show how MOHO can address real-life issues [to] enhance teaching and learning.” If you want to dive deeper into the MOHO model, it’s worth checking out if you haven’t already purchased it in school.

Integrating the MOHO into Occupational Therapy Practice

The MOHO allows us to dive into the why and how our patients live, work, and engage with their environment. In doing so, we can better understand what is important to them (i.e. their occupations) and integrate this into practice, which in essence is what makes us occupational therapists.

There are questions that you can ask yourself when working with a client or patient to look at the situation through a “MOHO lens”.

• Why are certain people motivated to do what they do? In other words, what are their values, interests, or occupations?
• How is occupational behavior organized or structured? What are an individual’s patterns, habits, or routines?
• How well can a person complete the task or occupation they are motivated to do?

Using MOHO Assessments

To further incorporate the MOHO in your OT practice, you start by using MOHO-related assessments during your evaluations and monitoring client progress throughout your intervention. The following are MOHO-based occupational therapy assessments that incorporate this frame of reference.

This list of MOHO-based assessments isn’t all-inclusive but it can help you get started, whether you’re working with children or adults. 

Occupational Questionnaire (OQ)

Occupational Self-Assessment (OSA)

Assessment of Motor Process Skills (AMPS)

Child Occupational Self Assessment (COSA)

Short Child Occupational Profile (SCOPE)

Pediatric Volitional Questionnaire (PVQ)

Modified Interest Checklist 

Occupational Performance History Interview-II (OPHI-II)

Worker Role Interview (WRI)

Volitional Questionnaire (VQ)

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Now that you’ve gotten into the MOHO model a bit more, you can see that it’s not so bad! The MOHO is a fascinating model that will allow you to connect with patients or clients on a deeper level by learning what motivates them and utilizing this in practice to further promote their health and well-being.

While the MOHO is a complex and dynamic framework that can seem overwhelming at first, by understanding its layers and intricacies one is able to continue to grow as an occupational therapy practitioner.

This article was co-written by Josh Albarado, OTR/L and Sarah Stromsdorfer, OTR/L. It was originally published on July, 1, 2020 and updated on February 2, 2022 and December 5, 2022.

References

Forsyth, K., Taylor, R., Kramer, J., Prior, S., Rickie, L., Whitehead, J.,…, Melton. J. (2014). The Model of Human Occupation. In Willard & Spackman’s Occupational Therapy (12th Ed), pp 505-524. Baltimore: Lippincott, Williams and Wilkins.

Kielhofner, G. (2002) A Model of Human Occupation: Theory and Application.(3rd Ed). Baltimore: Lippincott, Williams and Wilkins.

Model of Human Occupation: Theory and Application (University of Illinois Board of Trustees, 2020).

National Board for Certification in Occupational Therapy (2004). A practice analysis of entry-level occupational therapist registered and certified occupational therapy assistant practice. OTJR: Occupation, Participation, and Health, 24 (supplement 1), S1-S31.